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Arnqvist, Hans
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Publications (10 of 108) Show all publications
Davidson, L. T., Schilling, U. M., Arnqvist, H. J., Nyström, F. H. & Chisalita, S. I. (2023). Association of physiological stress markers at the emergency department to readmission and death within 90 days: a prospective observational study. Upsala Journal of Medical Sciences, 128(1), Article ID e9300.
Open this publication in new window or tab >>Association of physiological stress markers at the emergency department to readmission and death within 90 days: a prospective observational study
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2023 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 128, no 1, article id e9300Article in journal (Refereed) Published
Abstract [en]

Background: Predicting the risk of readmission or death in patients at the emergency department (ED) is essential in identifying patients who would benefit the most from interventions. We aimed to explore the prognostic value of mid-regional proadrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin, and high-sensitivity troponin T (hs-TnT) to identify patients with a higher risk of readmission and death among patients presenting with chest pain (CP) and/or shortness of breath (SOB) in the ED.

Methods: This single-center prospective observational study included non-critically ill adult patients with a chief complaint of CP and/or SOB who visited the ED at Linköping University Hospital. Baseline data and blood samples were collected, and patients were followed up for 90 days after inclusion. The primary outcome was a composite of readmission and/or death from non-traumatic causes within 90 days of inclusion. Binary logistic regression was used and receiver operating characteristics (ROC) curves were constructed to determine the prognostic performance for predicting readmission and/or death within 90 days.

Results: A total of 313 patients were included and 64 (20.4%) met the primary endpoint. MR-proADM > 0.75 pmol/L (odds ratio [OR]: 2.361 [95% confidence interval [CI]: 1.031 – 5.407], P = 0.042) and multimorbidity (OR: 2.647 [95% CI: 1.282 – 5.469], P = 0.009) were significantly associated with readmission and/or death within 90 days. MR-proADM increased predictive value in the ROC analysis to age, sex, and multimorbidity (P = 0.006).

Conclusions: In non-critically ill patients with CP and/or SOB in the ED, MR-proADM and multimorbidity may be helpful for the prediction of the risk of readmission and/or death within 90 days.

Place, publisher, year, edition, pages
Uppsala Medical Society, 2023
Keywords
Emergency department; chest pain; shortness of breath; copeptin; MR-proADM; MR-proANP; readmission; multimorbidity
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:liu:diva-193613 (URN)10.48101/ujms.v128.9300 (DOI)000990716800001 ()37223634 (PubMedID)
Note

Funding: Region Ostergotland [RO-610991, RO-351681, RO-340001, RO-430481, RO-533731, RO-534451, RO-599931, RO-421461, RO-966396]

Available from: 2023-05-08 Created: 2023-05-08 Last updated: 2025-02-10Bibliographically approved
Gutefeldt, K., Hedman, C., Thyberg, I., Bachrack Lindström, M., Arnqvist, H. & Spångeus, A. (2021). Low health-related quality of life is strongly linked to upper extremity impairments in type 1 diabetes with a long duration. Disability and Rehabilitation, 43(18), 2578-2584
Open this publication in new window or tab >>Low health-related quality of life is strongly linked to upper extremity impairments in type 1 diabetes with a long duration
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2021 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 43, no 18, p. 2578-2584Article in journal (Refereed) Published
Abstract [en]

Purpose: To compare health-related quality of life (HRQOL) in type 1 diabetes and non-diabetic controls and possible links to upper extremity impairments (UEIs). Prevalence of sick-leave and causes were investigated.

Materials and methods: This Swedish population-based case-control study included type 1 diabetes patients <67 years old and with a diabetes duration ≥20 years. Participants completed a postal questionnaire including Short Form 36, and questions regarding UEIs, and sick-leave.

Results: In total, 773 patients, aged 50 ± 10 years (diabetes duration 35 ± 10 years), and 708 non-diabetic controls, aged 54 ± 9 years, completed the study. Patients reported significantly lower HRQOL compared with controls. The difference was greatest for general health, vitality, and bodily pain. Patients with shoulder or hand but not finger impairments scored significantly lower than asymptomatic patients. The prevalence of sick leave was higher in patients vs. controls (23% vs. 9%, p < 0.001), and nearly half cited impairments from back, muscles, or joints as the main reason.

Conclusions: Health-related quality of life is lower in type 1 diabetes than controls and in patients with shoulder and hand impairments than in asymptomatic. Musculoskeletal impairments (back/muscle/joints) have impact on work ability. Identification of UEIs is important for initiating preventative-, therapeutic-, and rehabilitative interventions.

Implications for rehabilitation

  • Upper extremity impairments (UEIs) that are common in type 1 diabetes, and associated with reduced health-related quality of life, should preferably be screened for on a regular basis along with other known diabetes complications.

  • Early identification of UEIs is important to improve health by initiating preventive as well as therapeutic multi-professional rehabilitative interventions.

  • Sick leave is higher in type 1 diabetes than in controls. Musculoskeletal impairments, including the back, muscles, and joints, are a common cause for sick leave warranting further studies.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Quality of life; type 1 diabetes; upper extremity impairments; work ability; disability
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-163405 (URN)10.1080/09638288.2019.1705924 (DOI)000505880400001 ()31906725 (PubMedID)2-s2.0-85078623672 (Scopus ID)
Note

Funding Agencies|Medical Research Council South-east Sweden (FORSS); County Council; Stiftelseforvaltningen of Region Ostergotland, Sweden

Available from: 2020-02-04 Created: 2020-02-04 Last updated: 2022-04-26Bibliographically approved
Gutefeldt, K., Lundstedt, S., Thyberg, I., Bachrach-Lindström, M., Arnqvist, H. & Spångeus, A. (2020). Clinical Examination and Self-Reported Upper Extremity Impairments in Patients with Long-Standing Type 1 Diabetes Mellitus. Journal of Diabetes Research, 2020, Article ID 4172635.
Open this publication in new window or tab >>Clinical Examination and Self-Reported Upper Extremity Impairments in Patients with Long-Standing Type 1 Diabetes Mellitus
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2020 (English)In: Journal of Diabetes Research, ISSN 2314-6745, E-ISSN 2314-6753, Journal of Diabetes Research, Vol. 2020, article id 4172635Article in journal (Refereed) Published
Abstract [en]

Aim. The aims of the current study were (1) to determine the prevalence of upper extremity impairments (UEIs) in patients with type 1 diabetes by clinical investigation; (2) to investigate if self-reported impairments were concordant with clinical findings and if key questions could be identified; and (3) to investigate if answers to our self-reported questionnaire regarding UEIs are reliable. Methods. Patients with type 1 diabetes were invited to participate in a cross-sectional study of clinical and self-reported (12 items) UEIs in adjunction to ordinary scheduled clinical visit. Before the visit, a questionnaire on UEIs was filled in twice (test-retest) followed by clinical testing at the planned visit. Results. In total, 69 patients aged and with diabetes duration were included in the study. In the clinical examination, two-thirds (65%) of the patients showed one or more UEI, with failure to perform hand against back as the most common clinical finding (40%) followed by positive Phalen’s test (27%), Tinel’s test (26%), and Prayer’s sign (24%). UEIs observed by clinical examination were often bilateral, and multiple impairments often coexisted. Self-reported shoulder stiffness was associated with impaired shoulder mobility and with Prayer’s sign. Self-reported reduced hand strength was associated to lower grip force, Prayer’s sign, trigger finger, fibrosis string structures, and reduced thenar strength as well as reduced shoulder mobility. In addition, self-reporting previous surgery of carpal tunnel and trigger finger was associated with several clinical UEIs including shoulder, hand, and finger. The test-retest of the questionnaire showed a high agreement of 80-98% for reported shoulder, hand, and finger impairments. Conclusion. UEIs are common in type 1 diabetes. Self-reported shoulder stiffness and reduced hand strength might be used to capture patients with UEIs in need of clinical investigation and enhanced preventive and therapeutic strategies, as well as rehabilitative interventions.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2020
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-164549 (URN)10.1155/2020/4172635 (DOI)000522278400001 ()
Note

Funding agencies:  Medical Research Council of Southeast Sweden (FORSS); County council; Stiftelseforvaltningen of Region ostergotland, Sweden

Available from: 2020-03-24 Created: 2020-03-24 Last updated: 2025-02-11Bibliographically approved
Gutefeldt, K., Hedman, C. A., Thyberg, I. S., Bachrach-Lindström, M., Arnqvist, H. & Spångeus, A. (2019). Upper extremity impairments in type 1 diabetes with long duration: common problems with great impact on daily life. Disability and Rehabilitation, 41(6), 633-640
Open this publication in new window or tab >>Upper extremity impairments in type 1 diabetes with long duration: common problems with great impact on daily life
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2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 6, p. 633-640Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the prevalence, activity limitations and potential risk factors of upper extremity impairments in type 1 diabetes in comparison to controls.

METHODS: In a cross-sectional population-based study in the southeast of Sweden, patients with type 1 diabetes <35 years at onset, duration ≥20 years, <67 years old and matched controls were invited to answer a questionnaire on upper extremity impairments and activity limitations and to take blood samples.

RESULTS: Seven hundred and seventy-three patients (ages 50 ± 10 years, diabetes duration 35 ± 10 years) and 708 controls (ages 54 ± 9 years) were included. Shoulder pain and stiffness, hand paraesthesia and finger impairments were common in patients with a prevalence of 28-48%, which was 2-4-folds higher than in controls. Compared to controls, the patients had more bilateral impairments, often had coexistence of several upper extremity impairments, and in the presence of impairments, reported more pronounced activity limitations. Female gender (1.72 (1.066-2.272), p = 0.014), longer duration (1.046 (1.015-1.077), p = 0.003), higher body mass index (1.08 (1.017-1.147), p = 0.013) and HbA1c (1.029 (1.008-1.05), p = 0.007) were associated with upper extremity impairments.

CONCLUSIONS: Compared to controls, patients with type 1 diabetes have a high prevalence of upper extremity impairments, often bilateral, which are strongly associated with activity limitations. Recognising these in clinical practise is crucial, and improved preventative, therapeutic and rehabilitative interventions are needed. Implications for rehabilitation Upper extremity impairments affecting the shoulder, hand and fingers are common in patients with type 1 diabetes, the prevalence being 2-4-fold higher compared to non-diabetic persons. Patients with diabetes type 1 with upper extremity impairments have more pronounced limitations in daily activities compared to controls with similar impairments. Recognising upper extremity impairments and activity limitations are important and improved preventive, therapeutic and rehabilitation methods are needed.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Dupuytren’s disease, Type 1 diabetes, carpal tunnel syndrome, frozen shoulder, trigger finger disorder
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-144020 (URN)10.1080/09638288.2017.1397202 (DOI)000461521100002 ()29105514 (PubMedID)2-s2.0-85033477270 (Scopus ID)
Note

Funding agencies: Medical Research Council of Southeast Sweden (FORSS); County council of Region Ostergotland, Sweden; Stiftelseforvaltningen of Region Ostergotland, Sweden

Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2020-06-15Bibliographically approved
van Dijk, P. R., Logtenberg, S. J. J., Chisalita, I. S., Hedman, C., Groenier, K. H., Gans, R. O. B., . . . Bilo, H. J. G. (2016). Different Effects of Intraperitoneal and Subcutaneous Insulin Administration on the GH-IGF-1 Axis in Type 1 Diabetes. Journal of Clinical Endocrinology and Metabolism, 101(6), 2493-2501
Open this publication in new window or tab >>Different Effects of Intraperitoneal and Subcutaneous Insulin Administration on the GH-IGF-1 Axis in Type 1 Diabetes
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2016 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 101, no 6, p. 2493-2501Article in journal (Refereed) Published
Abstract [en]

Context: In type 1 diabetes mellitus, low levels of insulin-like growth factor -1 (IGF-1) and IGF binding protein-3 (IGFBP-3) and high levels of GH and IGFBP-1 are present, probably due to portal vein insulinopenia. Objective: To test the hypothesis that continuous ip insulin infusion (CIPII) has a more pronounced effect than sc insulin therapy on regulation of the GH-IGF-1 axis. Design: This was a prospective, observational case-control study. Measurements were performed twice at a 26-week interval. Setting: Two secondary care hospitals in the Netherlands participated in the study. Patients: There were a total of 184 patients, age-and gender-matched, of which 39 used CIPII and 145 sc insulin therapy for the past 4 years. Outcomes: Primary endpoint included differences in IGF-1. Secondary outcomes were differences in GH, IGFBP-1, and IGFBP-3. Results: IGF-1 was higher with CIPII as compared to SC insulin therapy: 124 mu g/liter (95% confidence interval [CI], 111-138) vs 108 mu g/liter (95% CI 102-115) (P = .035). Additionally, IGFBP-3 concentrations were higher and IGFBP-1 and GH concentrations were lower with CIPII as compared to SC insulin therapy: 3.78 mg/liter (95% CI, 3.49 - 4.10) vs 3.31 mg/liter (95% CI, 3.173.47) for IGFBP-3, 50.9 mu g/liter (95% CI, 37.9 - 68.2) vs 102.6 mu g/liter (95% CI, 87.8 - 119.8) for IGFBP-1 and 0.68 mu g/liter (95% CI, 0.44 - 1.06) vs 1.21 mu g/liter (95% CI, 0.95-1.54) for GH, respectively. In multivariate analysis, IGF-1 had no significant association with HbA1c. Conclusions: The GH-IGF-1 axis may be affected by the route of insulin administration with CIPII counteracting dysregulation of the GH-IGF1 axis present during sc insulin therapy.

Place, publisher, year, edition, pages
ENDOCRINE SOC, 2016
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-130291 (URN)10.1210/jc.2016-1473 (DOI)000378821100026 ()27115061 (PubMedID)
Note

Funding Agencies|Zwols Wetenschapsfonds Isala Klinieken; Sanofi-Aventis The Netherlands B.V.

Available from: 2016-07-31 Created: 2016-07-28 Last updated: 2017-04-24
Wahlberg Topp, J., Ekman, B., Nystrom, L., Hanson, U., Persson, B. & Arnqvist, H. (2016). Gestational diabetes: Glycaemic predictors for fetal macrosomia and maternal risk of future diabetes. Diabetes Research and Clinical Practice, 114, 99-105
Open this publication in new window or tab >>Gestational diabetes: Glycaemic predictors for fetal macrosomia and maternal risk of future diabetes
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2016 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 114, p. 99-105Article in journal (Refereed) Published
Abstract [en]

Aims: To investigate how glucose levels at diagnosis of gestational diabetes (GDM) are associated with infant birth weight and long-term risk of manifest diabetes mellitus in the mother. Methods: In a case control study GDM pregnancies (n = 2085) were compared with non-GDM pregnancies matched for day of delivery and obstetric unit (n = 3792). GDM was defined as capillary blood glucose (cB-glucose) &gt;9.0 mmol/l (plasma glucose &gt;10.0 mmol/l) after a 75 g oral glucose tolerance test (OGTT). The GDM cohort were followed up 8.5-13.5 yrs after initial diagnosis with a questionnaire, answered by 1324 GDM women (65%). Results: GDM women had higher mean infant birth-weight compared with controls (3682 g vs. 3541 g, P &lt; 0.001). In multiple linear regression analysis, birth weight was positively correlated to fasting cB-glucose at GDM diagnosis (P &lt; 0.001), increased week of gestation (P &lt; 0.001) and BMI before pregnancy (P &lt; 0.003), while 2 h OGTT cB-glucose values &gt;= 9.0 mmol/l were not related. Infants born to mothers with fasting cB-glucose &gt;= 4.5 mmol/l had no increased mean birth-weight or macrosomia (&gt;= 4500 g) compared to controls. In the follow up 334/1324 women (25%) of the GDM women had developed diabetes, 215 type 2 diabetes, 46 type 1 diabetes and 72 unclassified diabetes. In logistic regression fasting cB-glucose and 2 h OGTT cB-glucose at diagnosis of GDM as well as BMI &gt;25 and origin outside Europe were risk factors for manifest diabetes. Conclusions: Fasting blood glucose at diagnosis of GDM gives important information besides 2 h OGTT glucose about pregnancy outcome and future risk for maternal diabetes. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2016
Keywords
Birth weight; Pregnancy; GDM; Blood glucose; OGTT
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-128751 (URN)10.1016/j.diabres.2015.12.017 (DOI)000375129600015 ()26818892 (PubMedID)
Note

Funding Agencies|Swedish Diabetes Association; Medical Research Council of Southeast Sweden (FORSS); Linkoping University, Sweden

Available from: 2016-05-31 Created: 2016-05-30 Last updated: 2021-12-28
Van dijk, P. R., Logtenberg, S. J., Chisalita, I. S., Hedman, C. A., Groenier, K. H., Gans, R. O., . . . Bilo, H. J. (2015). After 6years of intraperitoneal insulin administration IGF-I concentrations in T1DM patients are at low-normal level.. Growth Hormone & IGF Research, 25(6), 316-319
Open this publication in new window or tab >>After 6years of intraperitoneal insulin administration IGF-I concentrations in T1DM patients are at low-normal level.
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2015 (English)In: Growth Hormone & IGF Research, ISSN 1096-6374, E-ISSN 1532-2238, Vol. 25, no 6, p. 316-319Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Low concentrations of insulin-like growth factor-I (IGFI) have been reported in type 1 diabetes mellitus (T1DM), suggested to be due to low insulin concentrations in the portal vein. The aim was to describe the long-term course of IGFI concentrations among T1DM subjects treated with continuous intraperitoneal (IP) insulin infusion (CIPII).

DESIGN: Nineteen patients that participated in a randomized cross-over trial comparing CIPII and subcutaneous (SC) insulin therapy in 2006 were followed until 2012. IGF-I measurements were performed at the start of the 2006 study, after the 6month SC- and CIPII treatment phase in 2006 and during CIPII therapy in 2012. Z-scores were calculated to compare the IGF-I concentrations with age-specific normative range values of a non-DM reference population.

RESULTS: In 2012, IGF-I Z-scores (-0.7; 95% confidence interval -1.3, -0.2) were significantly higher than at the start of the 2006 study (-2.5; -3.3, -1.8), the end of the SC (-2.0; -2.6, -1.5) and CIPII (-1.6; -2.1, -1.0) treatment phase with a mean difference of: 1.8 (0.9, 2.7), 1.3 (0.5, 2.1) and 0.8 (0.1, 1.6), respectively.

CONCLUSION: After 6years of treatment with CIPII, IGF-I concentrations among T1DM patients increased to a level that is higher than during prior SC insulin treatment and is in the lower normal range compared to a non-DM reference population. The results of this study suggest that long-term IP insulin administration influences the IGF system in T1DM.

Keywords
IGF-I; Intraperitoneal insulin; Type 1 diabetes mellitus
National Category
Endocrinology and Diabetes Physiology and Anatomy
Identifiers
urn:nbn:se:liu:diva-124061 (URN)10.1016/j.ghir.2015.08.007 (DOI)000366962800009 ()26336814 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden (FORSS); Stichting Zwols Wetenschapsfonds Isala Klinieken (ZWIK)

Available from: 2016-01-19 Created: 2016-01-19 Last updated: 2025-02-10
Nordwall, M., Abrahamsson, M., Dhir, M., Fredrikson, M., Ludvigsson, J. & Arnqvist, H. J. (2015). Comment: Response to Comment on Nordwall et al. Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden). Diabetes Care 2015;38:308-315 [Letter to the editor]. Diabetes Care, 38(8), e124
Open this publication in new window or tab >>Comment: Response to Comment on Nordwall et al. Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden). Diabetes Care 2015;38:308-315
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2015 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 38, no 8, p. e124-Article in journal, Letter (Other academic) Published
Abstract [en]

We thank Dr. Takahara (1) for the comment on our recent article exploring the impact of HbA1c, followed from diabetes onset, on the development of severe microvascular complications (2). As suggested, we have validated our results with Cox hazards analysis with severe microvascular events, i.e., laser-treated proliferative retinopathy and macroalbuminuria as a dependent variable and HbA1c (mmol/mol) as a time-dependent covariate.

For laser-treated proliferative retinopathy, we found a hazard ratio of 1.038 (95% CI 1.025–1.052, P < 0.001) and for macroalbuminuria, a hazard ratio of 1.075 (95% CI 1.050–1.100, P < 0.001).

Analyzing our data with Cox hazards analysis thus shows the strong influence of long-term HbA1c on severe microvascular complications, in agreement with our previous conclusions.

In our article, we chose to analyze and present the results in a way that was perhaps easier for a clinician to interpret and apply in clinical routine. With life-table analysis we found that the incidence of both laser-treated proliferative retinopathy and macroalbuminuria increased sharply and occurred earlier with increasing long-term weighted mean HbA1c. In the same manner, the prevalence of microvascular complications increased steeply with higher long-term weighted mean HbA1c, categorized in different groups.

In conclusion, our study irrespective of statistical methods shows a strong association between development of late complications and long-term mean HbA1c, and keeping the average HbA1c below 7.6% (60 mmol/mol) seemed sufficient to prevent microvascular complications for at least up to 20 years.

Place, publisher, year, edition, pages
American Diabetes Association, 2015
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-126409 (URN)10.2337/dc15-0939 (DOI)000358673200009 ()26207065 (PubMedID)
Available from: 2016-03-23 Created: 2016-03-23 Last updated: 2018-03-22Bibliographically approved
Nordwall, M., Abrahamsson, M., Dhir, M., Fredrikson, M., Ludvigsson, J. & Arnqvist, H. (2015). Impact of HbA(1c), Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden). Diabetes Care, 38(2), 308-315
Open this publication in new window or tab >>Impact of HbA(1c), Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)
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2015 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 38, no 2, p. 308-315Article in journal (Refereed) Published
Abstract [en]

OBJECTIVEHbA(1c) is strongly related to the development of diabetes complications, but it is still controversial which HbA(1c) level to strive for in the treatment of type 1 diabetes. The aim of the current study was to evaluate HbA(1c), followed from diagnosis, as a predictor of severe microvascular complications and to formulate HbA(1c) target levels for treatment.RESEARCH DESIGN AND METHODSA longitudinal observation study followed an unselected population of 451 patients diagnosed with type 1 diabetes during 1983-1987 before the age of 35 years in a region of Southeast Sweden. Retinopathy was evaluated by fundus photography and nephropathy data collected from medical records. HbA(1c) was measured starting from diagnosis and during the whole follow-up period of 20-24 years. Long-term weighted mean HbA(1c) was then calculated. Complications were analyzed in relation to HbA(1c) levels.RESULTSThe incidence of proliferative retinopathy and persistent macroalbuminuria increased sharply and occurred earlier with increasing long-term mean HbA(1c). None of the 451 patients developed proliferative retinopathy or persistent macroalbuminuria below long-term weighted mean HbA(1c) 7.6% (60 mmol/mol); 51% of the patients with long-term mean HbA(1c) above 9.5% (80 mmol/mol) developed proliferative retinopathy and 23% persistent macroalbuminuria.CONCLUSIONSLong-term weighted mean HbA(1c), measured from diagnosis, is closely associated with the development of severe complications in type 1 diabetes. Keeping HbA(1c) below 7.6% (60 mmol/mol) as a treatment target seems to prevent proliferative retinopathy and persistent macroalbuminuria for up to 20 years.

Place, publisher, year, edition, pages
American Diabetes Association, 2015
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-114569 (URN)10.2337/dc14-1203 (DOI)000348461400032 ()25510400 (PubMedID)
Note

Funding Agencies|Swedish Child Diabetes Foundation (Barndiabetesfonden); Medical Research Council of Southeast Sweden (Forskningsradet I Sydostra Sverige)

Available from: 2015-03-02 Created: 2015-02-26 Last updated: 2017-12-04Bibliographically approved
Svensson, M. K., Tyrberg, M., Nystrom, L., Arnqvist, H., Bolinder, J., Ostman, J., . . . Eriksson, J. W. (2015). The risk for diabetic nephropathy is low in young adults in a 17-year follow-up from the Diabetes Incidence Study in Sweden (DISS). Older age and higher BMI at diabetes onset can be important risk factors. Diabetes/Metabolism Research Reviews, 31(2), 138-146
Open this publication in new window or tab >>The risk for diabetic nephropathy is low in young adults in a 17-year follow-up from the Diabetes Incidence Study in Sweden (DISS). Older age and higher BMI at diabetes onset can be important risk factors
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2015 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 31, no 2, p. 138-146Article in journal (Refereed) Published
Abstract [en]

AimsThe main objective of this study was to estimate the occurrence of diabetic nephropathy in a population-based cohort of patients diagnosed with diabetes as young adults (15-34years). MethodsAll 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) were invited to a follow-up study 15-19years after diagnosis, and 468 (58%) participated. Analysis of islet antibodies was used to classify type of diabetes. ResultsAfter median 17years of diabetes, 15% of all patients, 14% T1DM and 25% T2DM, were diagnosed with diabetic nephropathy. Ninety-one percent had microalbuminuria and 8.6% macroalbuminuria. Older age at diagnosis (HR 1.05; 95% CI 1.01-1.10 per year) was an independent and a higher BMI at diabetes diagnosis (HR 1.04; 95% CI 1.00-1.09 per 1kg/m(2)), a near-significant predictor of development of diabetic nephropathy. Age at onset of diabetes (p=0.041), BMI (p=0.012) and HbA1c (pless than0.001) were significant predictors of developing diabetic nephropathy between 9 and 17years of diabetes. At 17years of diabetes duration, a high HbA1c level (OR 1.06; 95% CI 1.03-1.08 per 1mmol/mol increase) and systolic blood pressure (OR 1.08; 95% CI 1.051.12 per 1mmHg increase) were associated with DN. ConclusionsPatients with T2DM diagnosed as young adults seem to have an increased risk to develop diabetic nephropathy compared with those with T1DM. Older age and higher BMI at diagnosis of diabetes were risk markers for development of diabetic nephropathy. In addition, poor glycaemic control but not systolic blood pressure at 9years of follow-up was a risk marker for later development of diabetic nephropathy.

Place, publisher, year, edition, pages
Wiley: 12 months, 2015
Keywords
diabetic nephropathy; hyperglycaemia; blood pressure; type 1 diabetes mellitus; type 2 diabetes mellitus; islet antibodies
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-116523 (URN)10.1002/dmrr.2574 (DOI)000349969600003 ()25044633 (PubMedID)
Note

Funding Agencies|Swedish Diabetes Association; Lundstrom Foundation; Novo-Nordisk Foundation; Malmo University Hospital; Swedish Research Council [14531, 14287]; Juvenile Diabetes Research Foundation-Wallenberg Diabetes Research Program [K98-99 JD-128B]; Swedish Life Insurance Foundation; Trygg-Hansa Foundation; Faculty of Medicine at Umea University; Swedish Association for Patients with Kidney Disease; Swedish Society of Medicine and Heart and Lung foundation

Available from: 2015-03-27 Created: 2015-03-27 Last updated: 2017-12-04
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